Starting this month, transgender state employees in Maryland can access transition-related health care under the state insurance plans. The change came as the result of a lawsuit filed on behalf of a transgender employee of the University of Maryland.

FreeState Legal, the firm representing the university employee, Sailor Holobaugh, publicly announced the decision on Tuesday, but the changes technically took effect earlier in the month.

“Maryland has moved one step closer to achieving full equality and justice for transgender Marylanders,” said Aaron Merki, executive director of FreeState Legal, in a press release.

Holobaugh, a clinical research assistant in the neurology department at the university, decided to file the lawsuit with FreeState after being denied coverage for a mastectomy, which he had already undergone and for which he had paid out of pocket—the total cost of the procedure was $6,500. The state denied coverage of the treatment based on an exclusion barring treatment “designed to alter an individual’s physical characteristics to those of the opposite sex.”

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In the complaint, filed last November, FreeState alleges that the failure to cover the cost of the surgery amounts to gender discrimination, which is prohibited in Michigan.

As part of the settlement agreement reached with Holobaugh this month, the state not only agreed to pay for the majority of the procedure’s cost, but also to remove the transgender exclusion it had used to justify its actions from all of its state employee health plans. In addition, the state agreed to add language to all insurance plans that guarantees coverage of transition care. Called the Gender Dysphoria Benefit, the provision ensures coverage of medically necessary treatment, “including hormone replacement therapy and a variety of surgical procedures,” according to FreeState.

The shift in policy makes Maryland only the third state in the country to allow coverage of transition-related care under state insurance plans. California and Oregon have similar policies.

In a press statement, Holobaugh said he is “thrilled that people who serve Maryland as State employees have increased access to services, and that they can extend these benefits to their dependents.”